Most patients with large ventricular septal defect (VSD) are dead by age 40 years. The average age at death in unoperated patients with isolated, large (greater than or equal to 2 cm) VSD is about 35 years. Thus, survival in our patient to 63 years with a 2.5 cm VSD is extraordinary. Indeed, we found detailed descriptions at necropsy in only 5 patients with isolated, large (greater than or equal to 1.5 cm) VSD surviving greater than 40 years without operation. Their ages ranged from 44-60 years (mean 51). Only 1 had cardiac catheterization. The systemic arterial pressure was provided in only 1 patient and it was elevated (indirect = 180/120 mm Hg) as it was in our patient (indirect 170/120 mm Hg).